Showing posts from category environmental health.
-
Disease in the Developing World
Poverty, Politics, and Pollution
›November 15, 2010 // By Ramona GodboleA look at the most common illnesses that kill people in the developing world reveals, for the most part, easily preventable and/or treatable diseases and conditions, highlighting the deep disparities between health systems in rich and poor countries. But many of the causes and solutions to these common diseases are also linked to political and environmental factors as well as economic.
Cholera: “A disease of poverty”
Ten months after the earthquake that killed more than 230,000 people, Haiti is facing yet another disaster – a cholera outbreak. The current health crisis highlights broader structural and political issues that have plagued Haiti for years.
Cholera, an intestinal infection caused by bacteria-contaminated food or water, causes severe diarrhea and dehydration, but with quick and effective treatment, less than one percent of symptomatic people die according to the World Health Organization. According to BBC, as of November 15, more than 14,000 people have been hospitalized and over 900 deaths have been attributed to cholera in Haiti thus far.
Even before the earthquake, conditions in Haiti, the poorest country in the Western hemisphere, were bleak. The country has very high maternal and child mortality rates (again, highest in the Western hemisphere), and is in the midst of an ongoing environmental crisis, due to deforestation, soil loss, and flooding.
Less than 40 percent of the Haitian population has access to appropriate sanitation facilities and clean water is scarce, according to UNICEF. Displacement, rapid population growth, and destroyed infrastructure in the wake of the earthquake exacerbated already poor conditions and public health officials warned of the increased risk of cholera and other diarrheal diseases after the disaster.
Today these fears have become reality. While public health messages urging Haitians to wash their hands, boil drinking water, and use oral rehydration salts are working to control the current outbreak, long-term solutions to prevent future outbreaks will require much more systematic changes.
As Partners in Health Chief Medical Officer Joia Mukherjee puts it, cholera is “a disease of poverty.” Citing a joint report from Partners in Health and the Robert Kennedy Center for Human Rights, Mukherjee notes that in 2000, loans from the Inter-American Development Bank to improve water, sanitation, and health (including the public water supply in the Artibonite Valley, where the cholera outbreak originated) were blocked for political reasons by the U.S. government, in an effort to destabilize former President Aristide.
The failure of the international community to assist Haiti in developing a safe water supply, writes Mukherjee, has been a violation of the basic human right to water. To halt the current cholera epidemic and prevent future outbreaks, providing water security must become a priority in the reconstruction efforts of the international community.
Politics and Polio
Recent reports have indicated that the global incidence of polio, a highly infectious, crippling, and potentially fatal virus, is significantly declining and a new vaccine is renewing hopes of eradication. Nigeria, one of the few countries where polio continues to be endemic, has also made major progress over the last few years.
But the situation was very different just a few years ago. In 2003 religious and political leaders in Northern Nigeria banned federally sponsored polio immunization campaigns, citing “evidence” that the polio vaccine was contaminated with anti-fertility drugs intended to sterilize Nigerian women. The boycott led to an outbreak of the disease that spread to 20 countries and caused 80 percent of the world’s cases of polio during the length of the ban, according to a study in Health Affairs.
While the boycott was eventually stopped through the combined efforts of local, national, and pressure, the boycott serves as a useful reminder that global health problems can have political, rather than biological or behavioral, origins.
Combating Climate Change and Pneumonia
Studies from the World Health Organization indicate that exposure to unprocessed solid fuels increases pneumonia risk in children by a factor of 1.8, but today more than three billion people globally continue to depend on coal and biomass fuels for their cooking and heating needs.
Cooking and heating with these fuels creates levels of indoor air pollution that are up to 20 times higher than accepted WHO guidelines, putting people at considerable risk for lower respiratory infections. Women, who are often responsible for collecting fuel and performing household tasks like cooking, and their children, are particularly at risk. Today, exposure to indoor air pollution is responsible for 1.6 million deaths globally including more than 900,000 of the two million annual deaths from pneumonia in children under five years old, representing the most important cause of death in this age group.
A recent study from The Lancet shows improved cooking stoves could simultaneously reduce greenhouse gas emissions and the global burden of disease caused by indoor air pollution in developing countries. Such an intervention, the authors argue, could have substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischemic heart disease. The potential health benefits don’t stop there: fuel-efficient stoves can also improve the security of women and children in conflict zones and decrease the risk of burns while improving local air quality.
There would be significant environmental benefits as well. A World Wildlife Fund project in Nepal, which provided loans to purchase biogas units and build improved cookstoves, curbed deforestation for firewood and grazing as well as reduced the incidence of severe cases of acute respiratory infection among under-five children.
Overall, greater access to modern cooking fuels and improved cooking stoves in the developing world could both mitigate climate change and make significant contributions to MDGs 4 & 5, which focus on the reduction of child and maternal mortality.
Prescription for Change
The international community’s experience with cholera in Haiti, polio in Nigeria, and pneumonia around the world shows that health issues in developing countries rarely occur in a vacuum. As these three cases demonstrate, politics, environmental, and structural issues, for better or worse, play an important role in health affairs in the developing world. Yet efforts to combat these conditions often focus only on prevention and treatment.
Antibiotics and vaccines alone cannot provide solutions to these problems. Employing economic, diplomatic and policy tools to address health and development challenges can save lives. More specifically, public health efforts should not only focus on poverty reduction, but also target environmental, political, and structural issues that contribute to disease globally.
Sources: BBC, Bill and Melinda Gates Foundation, CIA World Factbook, Health Affairs, The Lancet, Scientific American, UNICEF, United Nations, USAID, World Health Organization, and World Wildlife Fund.
Photo Credit: “Lining up for vaccination,” courtesy of flickr user hdptcar. -
John Bongaarts on the Impacts of Demographic Change in the Developing World
›“The UN projects about 9.1 billion people by 2050, and then population growth will likely level off around 9.5 billion later in the century. Can the planet handle 9 billion? The answer is probably yes. Is it a desirable trajectory? The answer is no,” said John Bongaarts, vice president of the Policy Research Division at the Population Council, in this interview with ECSP.
Although family planning was largely brushed aside by international policymakers following the 1994 UN International Conference on Population and Development in Cairo, Bongaarts said he is hopeful because it is now enjoying a higher profile globally – and receiving greater funding.
“I am optimistic about the understanding now, both in developing and developed world, and in the donor community, that [family planning] is an important issue that should be getting more attention,” Bongaarts said. “And therefore I think the chances of ending up with a positive demographic outlook are now larger than they were a few years ago.”
The “Pop Audio” series is also available as podcasts on iTunes. -
Blue Ventures’ Integrated PHE Initiative in Madagascar
›In the small coastal village of Andavadoaka, Madagascar, the village elders offer a bottle of rum and two cigarettes to their ancestors before the men and their sons launch their wooden dugout canoes into the sea. Leaning over the side, their masked faces scour the water for their prey.
Meanwhile, the women – with babies on back and spears in hand – set out on foot into the shallow waters. One probes a small hole with her spear, and a tentacle reaches out to grapple with it. After careful coaxing, she pulls out an octopus, kills it, and adds it to her collection, which she tows on a string behind her.
In total, more than 1,850 pounds of octopus are collected on the opening day of the octopus harvest, a seasonal occurrence in Velondriake, the Indian Ocean’s first locally managed marine area.
Velondriake, which means “to live with the sea,” stretches along more than 40 km of southwestern Madagascar’s coast. The region encompasses 25 villages and is home to more than 8,000 people of the Vezo ethnic group, who are almost entirely dependent on marine resources, such as octopus, fish, and mangrove forests, for subsistence and income. But these resources are quickly disappearing due in large part to over-harvesting.
Blue Ventures Conservation – the London-based NGO I work for – has been working in the area since 2003 to protect the region’s coral reefs and mangroves, as well as their biological diversity, sustainability, and productivity, while also improving the quality of life of the local community.
To this end, Blue Ventures helped the community create a series of coastal marine reserves. Several permanent reserves protect the biodiversity of the coral reefs and mangroves, and help fish populations recover; while nearly 50 temporary reserves have increased the productivity of the octopus and crab fisheries. Octopuses reproduce quickly and juveniles grow at a nearly exponential rate, so a brief harvesting hiatus can lead to significant increases in yield. Increased yields translate to increased profits – something greatly welcomed by the people of this impoverished region.
The people of the region are also reproducing quickly: the average total fertility rate in Velondriake is 6.7 children per woman, according to our data. On average women are only 15 years old when they first conceive. To compound this problem, a majority of the population is under the age of 15 – at or approaching reproductive age. At the current growth rate, the local population will double in only 10 to 15 years. The local food sources, already heavily depleted, barely feed the current population, let alone twice that amount. Without enabling these coastal communities to stabilize their population growth, efforts to improve the state of marine resources and the community’s food security are considerably hindered.
In August 2007, Blue Ventures launched its Population, Health, & Environment (PHE) program as a weekly family planning clinic in Andavadoaka, which provided access to ingestible and injectable birth control options, as well as condoms. The clinic increased the village’s contraceptive prevalence rate (CPR) from 9.4 percent to 36.3 percent, and the Velondriake region’s CPR from 11.0 percent to 15.1 percent, in its first two years. (CPR data for the third year is not yet available, but should be notably higher, especially at the regional level.)
In 2009, Blue Ventures opened two more clinics and began holding quarterly outreach clinics in all Velondriake villages. We started offering long-acting, reversible contraceptive options, including Implanon and IUDs. Most recently, we have implemented a community-based distributor (CBD) program to provide wider access to contraceptives around the region, particularly for villagers that could not easily reach one of the clinic sites. These expansions paid dividends: the number of patients increased almost four-fold between the second and third years, with a cumulative total for all three years of just under 1,700 patients.
Recently, the PHE program began a partnership with the UN Population Fund (UNFPA), becoming the first PHE project to receive support from the UNFPA within Madagascar. The UNFPA funds will allow us to add new regional clinics; launch a behavior change campaign, including a regional theater tour and educational events; and further develop the CBD program.
UNFPA’s support of this initiative represents an important endorsement of Blue Ventures’ integrated approach to the challenges of marine sustainability, food security, reproductive health, and population growth. Funding applications to focus on improving maternal and infant health and to conduct a full health-needs assessment of the Velondriake region are pending.
In taking a population, health, and environment approach, Blue Ventures creates synergies that allow for the more effective achievement of health and conservation outcomes. Through providing family planning and health options – services the community really wants – Blue Ventures generates more support for all of its other initiatives, such as conservation and aquaculture programs.
This integrated multi-pronged approach also helps speed up the move towards a more sustainable future. By empowering and enabling couples to take control of their fertility, couples are able to have the size family they want. The use of family planning helps lower the population growth rate, and lower growth rates decrease pressures on natural resources. Decreased pressures on natural resources lead to healthier ecosystems; healthier ecosystems mean more natural resources available; and more resources lead to healthier families.
Through recognizing this inextricable link between communities, their health, and the environment they live in, Blue Ventures hopes to preserve not just the local coral reefs and mangroves, but the Vezo seafaring lifestyle. This way, the sons on the boats and the babies on the women’s backs may still have enough octopus and fish to harvest when they take their own children out to sea.
Matthew Erdman is the PHE coordinator for Blue Ventures. For more information about Blue Ventures’ PHE activities, please contact phe@blueventures.org, or visit their website at www.blueventures.org.
Photo Credit: Adapted from “07,” courtesy of Blue Ventures. -
Tamara Kreinin on Women’s Empowerment, Population Growth, and Sustainability
›“We know that when that when we empower women – whether it’s giving them control over their bodies and access to family planning or whether it’s by including them in planning around climate change – their agency can make huge leaps for us,” said Tamara Kreinin, executive director of women and population at the UN Foundation, in this interview with ECSP.
Seventy percent of the world’s poor are women and they’re also the members of the household most likely to be responsible for food, water, and firewood collection.
“At the same time, we know that women are often not at the table,” she said. “They’re not at the table in country when countries are creating aid to adaptation strategies around the environment and climate change, and they’re not at the table at places like Copenhagen and some of the big climate change meetings.”
The “Pop Audio” series is also available as podcasts on iTunes. -
PATH Foundation’s ‘Population, Health, and Environment Leadership as a Way of Life’
›PATH Foundation Philippines, Inc. (PFPI) just released a short documentary, Population-Health-Environment (PHE) Leadership as a Way of Life in All Walks of Life. The video features interviews with peer educators and local government officials who have partnered with PFPI on integrated coastal resource management in the Philippines that combines family planning and reproductive health services with environmental services.
According to those interviewed, an integrated approach is the best way to alleviate food insecurity in the area. “We cannot separate population, health, and environment, they should be implemented hand in hand,” said Marlyn Alcanises, a Fisheries and Coastal Resource Management program officer. “Even if we manage our coastal resources well, if there are many children due to high fertility and population growth, many people are hungry.”
The comprehensive program has been successful in addressing the social and environmental problems in the Verde Island Passage of the Philippines, one of Asia’s most densely populated regions, as well as a marine biodiversity hotspot and sea lane for many commercial ships.
The program uses community-based distribution of contraceptives to increase access to family planning, micro-credit schemes to finance sustainable livelihoods and alleviate poverty, and advocacy campaigns to increase government support for integrated health and environment programs.
Municipal Planning and Development Coordinator Cecilia Zulueta praised the integrated approach, saying “it can slow down population growth, decrease the number of malnutrition cases, lessen the number of out-of-school youth, and it can also decrease the crime rate, because if one does not have a stable source of income it may force him to engage in illegal activities.”
In ECSP’s FOCUS Issue 15, “Fishing for Families: Reproductive Health and Integrated Coastal Management in the Philippines,” Joan Castro and Leona D’Agnes demonstrated that PFPI’s Integrated Population and Coastal Resource Management project (IPOPCORM) was more cost-effective and had a greater impact on the wellbeing of both human reproductive health and coastal resources than non-integrated programs. In a study measuring the impacts of integrated versus single-sector reproductive health (RH) or coastal resource management (CRM) programs, they found the integrated approach met or exceeded single-sector outcomes for 26 out of 27 indicators.
Reducing high fertility rates reduces pressure on natural resources, decreases high rates of malnutrition, crime and HIV/AIDS, and preserves local fisheries, “making life sustainable for both humans and nature,” as PFPI puts it in the documentary. The hope is that the community leaders featured in the documentary will inspire others in similar situations to take the lead on integrated issues in their communities.
“Even if we are doing environmental conservation through population management in our province but the others are not, it will still create conflict somehow,” said Alcanises. “I believe that whatever program is being done in one province should also be done in other provinces, in order to avoid conflict and promote balance in program implementation.”
Julio Lopez, president of the Galera Association of Managers and Entertainers said, “this land is ours, and we are responsible in taking care of it.”
PFPI, along with the University of Rhode Island’s Coastal Resource Center and Conservation International, is part of the BALANCED project, which last year launched the PHE Toolkit as a resource for PHE professionals. For more on PFPI’s IPOPCORM program, see ECSP’s interviews with Joan Casto and Leona D’Agnes on our YouTube channel: “Joan Castro – Integrated Population and Coastal Resource Management (IPOPCORM)” and “Leona D’Agnes on Population, Health, and Environment.”
Video Credit: “Population-Health-Environment (PHE) A Video Documentary,” courtesy of YouTube user PATHFoundationPhils.
Sources: Population Reference Bureau. -
Assessing Our Impact on the World’s Rivers
›In a special “Rivers in Crisis” issue of Nature, the lead article, “Global Threats to Human Water Security and River Biodiversity,” presents damning evidence that manipulation of river systems — through the construction of canals, levees, hydroelectric projects, and other infrastructure — has caused serious and lasting biological damage to watersheds throughout both the developing and developed worlds. The authors (all 11 of them!) report that key rivers have become shadows of their former selves in terms of the amount of aquatic life they can support. Without drastically improved stewardship of waterways, “we are pushing these river systems toward catastrophe,” warns Peter McIntyre, an article co-author.The human impact on the world’s river systems will be hard to reverse, says Margaret Palmer, author of a second Nature article on freshwater biodiversity loss, “Beyond Infrastructure.” Human-induced changes to watersheds affect local hydrology at a fundamental level, she contends, weakening rivers’ ability to deliver crucial “ecological goods and services” — such as clean water and nutrient-rich sediment loads — that help maintain the health of local environments and the human populations that depend on them. To fully understand the scope of the problem, Palmer says more research is needed to explore the linkages between biodiversity levels and “ecosystem services” that healthy rivers provide. -
Welcome Back, Roger-Mark: A Powerful Voice Returns to PHE
›October 13, 2010 // By Geoffrey D. Dabelko“I’m thrilled to be back.” That was the sentiment that Roger-Mark De Souza relayed to me, in his famous lilting baritone, about becoming the new vice president of research and director of the climate program at Population Action International (PAI). De Souza has long been a leading voice on integrated development programs that feature population, health, and environmental (PHE) dimensions. But three years as the Sierra Club’s director of foundations and corporate relations took him away from day-to-day work on these issues.
In his new posts, Roger-Mark will lead PAI’s research team in establishing a strong evidence base and engaging new allies in the effort to support healthier women and families, according to PAI. “Roger-Mark’s diverse research experience makes him an ideal fit for PAI as we undertake critical projects on reproductive health, population and environment issues,” said PAI President and CEO Suzanne Ehlers in a press release.PAI is a research-based advocacy NGO long known for innovative work connecting demographic considerations with other key development realms: mainly environment, security, and poverty. PAI’s policy-friendly briefs on population’s links with water, forests, and biodiversity provide practical meta-analysis of these complex and evolving connections. The organization’s more recent work on demographic security has been instrumental in advancing research and policy in that largely neglected arena.
De Souza captured his insights last year for our Focus series, in his brief, “The Integration Imperative – How to Improve Development Programs by Linking Population, Health, and Environment” (see also his follow-up interview on NSB). He combines lessons learned from community-based development efforts in Southeast Asia and East Africa with a savvy sense of the policy debates among donors and recipient countries alike.
This move reunites De Souza with Kathleen Mogelgaard, with whom he made key contributions to the PHE field as colleagues at Population Reference Bureau earlier this decade, and who is now Senior Advisor for Population, Gender, and Climate at PAI.
De Souza returns to his former focus on PHE issues at a time when the field is collectively searching for the best ways to respond to the challenges of climate mitigation and adaptation, as well as ongoing hurdles such as scaling up, sustainability, and labeling. -
The “Condom King” speaks at TEDxChange on Poverty Reduction and a “9th MDG”
›“We have now found the weapon of mass protection,” said Mechai Viravaidya (a.k.a. the “Condom King”) at the recent TEDxChange event in New York. Viravaidya is the founder and chairman of the Population and Community Development Association and a former senator of Thailand. He spoke about his innovative approaches to addressing Thailand’s once high rates of poverty, child mortality, and HIV through the promotion of family planning and condom use.
